Low carb diets are trending everywhere right now, especially the latest Carnivore Diet, which is comprised of eating only meat and animal products. And although low carb, high protein diets do help support weight loss increasing satiety and therefore naturally reducing calorie intake, it doesn't mean staying on them long term continues to be beneficial for health. Rather they may be doing your gut more harm than good, especially if consumed for the long term.
Research has found that diets high in fat (especially saturated fat) and protein, and consequentially low in fiber, increases the abundance of pro-inflammatory gram negative bacteria in the gut called Bacteroides and other bile loving proteobacteria like Bilophila. These bugs produce a very pro-inflammatory endotoxin called lipopolysaccharide (LPS) which causes inflammation at the gut lining, leading to leaky gut, and increased absorption of LPS into systemic circulation. LPS in elevated amounts plays an important role in the development of IBD and other metabolic diseases. Furthermore, artificial sweeteners often used in low carb diets, continue to shift the gut microbiome towards dysbiosis (an imbalance of good vs bad bacteria), favoring gram negative bacteria.
On the other hand, a diet rich in complex carbohydrates and fibers (including prebiotic and polyphenol rich plant foods) provides a good source of microbiota accessible carbs, which supports the growth of gram positive bacteria such as commonly known Bifidobacterium and Lactobacilli as well as other beneficial bacteria such as Akkermansia muciniphila. These beneficial microbes provide many metabolic benefits to the host.
So how much fat and protein should an adult consume daily? Research found that diets consisting of 40% or more of calories from fat, shifted the microbiome unfavorably. As for protein, it seems a moderate intake is ideal, neither too little or too much. Since protein is essential for optimal metabolic health too little can impair cellular growth and repair, digestion, thyroid function, and fluid balance in the body. Too much protein on the other hand can lead to protein putrefaction in the colon and increase the risk for colon cancer. Therefore, I generally recommend 25-30g of protein per meal (or about 15-20% of calories) from a variety of different sources, including both plant-based and grass-fed/wild-caught meats and seafood.
To sum it up, good bacteria like a varied whole foods, plant focused diet, with moderate amounts of quality fat and protein. Therefore, if you have been following various versions of low carb/high protein diets for many years and still are not feeling your best, then it may be time to switch it up for your gut health and ultimately YOUR health. Instead of opting for three slices of bacon, sausage, and coffee with coconut cream for breakfast, add some COLOR and some SPICE! A microbiome loving breakfast could include poached eggs over curried lentils and spinach with a side of fresh fruit.
However, if you struggle with IBS or SIBO, inflammation caused by poorly controlled Celiac Disease or IBD, or a stealth infection, then a diet high in fiber rich foods is not indicated until treated and inflammation has subsided. Speak with your dietitian if you have concerns.
What are your thoughts? I love to hear from you!
I used to be a runner, or at least that is what I called myself. For about a decade of my life, I ran most days of the week. At first it began as a way to stay fit while in college. I used to play sports in high school which kept me active. However, in college, between studies and a part-time job, I couldn’t afford to be involved in sports. I needed a cheap and easy way to stay in shape, so I picked up running. I could do it anywhere, anytime, and all I needed was a pair of running shoes. It was perfect for the poor college student.
Initially, it was hard. I ran seven minutes in one direction and then seven minutes back. Week by week, the distance gradually grew longer, and it felt good. Running was a personal escape from reality and my ever racing mind. It was meditative with my rhythmic breath. As the distance grew, I explored the trails and neighborhoods around me I otherwise would not have seen. I felt like a bounding deer jumping over rock and stone while winding my way around each bend. I even got to explore the streets of Barcelona in the early mornings. Everyone was still sleeping and the city was peaceful, a sight only few get to witness. Eventually I was running 4-8 miles most days of the week, with an occasional 10-12 mile long run on the weekend. I looked and felt healthy, emotionally and physically. It was a beautiful love affair.
However, as time went on, running became an unhealthy obsession. I had to run in order to feel good about myself. No longer was running an enjoyable way to move my body and explore the world around me. Instead running became a chore. If I didn't run, I felt guilty. If the run wasn't long enough or fast enough, I felt guilty. I always timed myself, and I always tracked the distance I ran. No longer was I running out of pure joy, nor was it brining me joy. I was chained to my own prison of fear.
Eventually I stopped, all because of a biking accident. I hurt my knee in a collision with a car door and could no longer run downhill without severe pain. A year later I completed physical therapy and was told not to run for 8 weeks. At first I was distraught. However, during this break I realized the relationship I had with running was hurting my mental and physical health. Who cared if I ran a 7 min mile or ran a half marathon?? NOBODY!! I wasn't a professional athlete. I was simply competing with myself. But why?? In the name of health? Because of my ego? Or the desire to keep my running figure? It was all a mess, and I was a mess. In those two months, I realized, I would be thankful if I could ever run again without pain, no matter the distance, no matter the speed.
Now five years later, I run, but only occasionally when the mood strikes. Instead I thoroughly enjoy walking, hiking, and simply being outdoors. My past self would feel aghast at my current exercise regimen. I have no structure, no routine, and I simply do what sounds good to me in the NOW. However, when the desire to run is strong, I choose to run NAKED. I leave my home with nothing, no phone, no watch, no music, nothing. I simply run to run undistracted by today’s technology and to be present in the NOW. I want to feel the fresh breeze on my skin, to breath rhythmically with my step, and to explore the nature around me. And perhaps not even think at all. I run at a pace that feels good, not rushed. And I stop, whenever I want to. Sometimes simply to rest on a sunny bench in the park, or to admire some flowers along the way.
In retrospect, the accident was a gift. It forced me to change an unhealthy pattern. Otherwise, I may still be stuck in the cycle of fear and guilt. Ultimately, I am healthier today (both mentally and physically) than I was then. My hope is that this essay may bring to light your relationship with exercise and movement. Do you move because you have to or should? Or do you move because you want to? And are you moving your body in a way that feels good and brings you joy? Or are you constantly pushing your limits? If you feel caught in a similar cycle, then I encourage you to honestly evaluate your relationship with exercise. Instead of letting numbers or unrealistic goals define you, opt for presence and kindness. Kindness to yourself and presence in your being. And always opt to move NAKED, free of devices that keep us from being present in the NOW. If you have been there or are there, you are not alone, we are not alone. Let’s run NAKED together!
In practice, many of my clients come to me not eating enough protein, which is leaving them hangry and fatigued. Often they tell me they cannot go for long periods without eating, and are constantly snacking or grazing. Plus, they are not noticing any improvement in lean body mass despite increased effort at the gym or on the trails.
Although the RDA for dietary protein is 0.8g/kg per day (about 10% of calories), this is based largely on the MINIMUM needed to avoid deficiency, but not to support optimal metabolic health. The acceptable macronutrient distribution range (AMDR) for protein is 10-35% of daily calories. However, research suggests that 1.2-1.6g/kg (or about 20% of calories) is ideal for metabolic benefits. For an average 130lb woman eating ~1800kcal per day that equals to 75-90g per day.
Interestingly, on average Americans eat about 16% of their daily calories from protein. A vast majority (60%) of that protein is coming in at ONE meal and less than 15g of protein is consumed at breakfast. This practice may not be helping Americans. Researchers have found that a protein intake of ~30g per meal has positive effects on lean body mass and muscle protein synthesis when compared to meals containing <20g per meal. Furthermore, spacing total daily protein out over 3-4 meals is a very positive habit to enforce for many reasons. Find out more below.
So why is protein important?? Protein is required for cellular growth and repair, the production of enzymes that are necessary for sustaining life, for hormone production (thyroid, dopamine, adrenaline, melatonin, insulin, etc), for proper fluid balance in the body, nutrient transport and storage, for healthy immune function, and soooo much more. Plus, protein helps increase our satiety hormone leptin, speeds up our metabolism, improves blood sugar control, and reduces snacking behavior. Therefore, by spacing protein out evenly over 3-4 meals per day, you will feel more energized, free of constant cravings, and better to able to listen to your hunger and satiety cues. Without enough protein, especially quality protein, our health declines.
What is quality protein? The type of protein you choose is definitely important to meet your health goals. Conventional meats and dairy have a less desirable nutrient profile. Therefore, I recommend a variety of grass-fed beef, wild caught seafood, pasture raised poultry and eggs, pasture raised pork, organic beans and legumes, and organic grass-fed dairy if tolerated. Organic whole grains, nuts, and seeds also provide small amounts of protein. Supplements such as grass-fed collagen peptides, grass-fed whey protein, or organic pea/hemp/rice protein powders can be helpful to meet your goal.
Although protein is very important, more isn't always better. Pairing a small portion (4oz) of protein with both carbohydrates and fats is ideal. Not only does this macronutrient balance increase satisfaction (and satiety), it also increases nutrient density, and supports hormone balance.
Meats, Seafood, & Poultry — 3 ounce portions or ~ 1/2 cup (20-25g)
Beans/Legumes — 1 cup cooked (~15g)
Meat Alternatives (Extra Firm Tofu/Tempeh) - 3oz (~15g)
Whole Grains — 1 cup cooked (~8g)
Nuts & Seeds — 1/4 cup whole (~9g), 2 T Nut Butter (~6g)
Dairy Products — 1 cup milk, regular yogurt, or 1 oz cheese (~8g)
Chicken Eggs — 1 egg (6g)
Protein Powders — 1 serving (10-20g) varies a lot depending on the product
To those of you who made it to the end, thank you! Are you mindful of your protein intake? Are you already meeting the goal of 25-30g per meal or is it a struggle for you? I would love to hear from you. Let me know in the comments below!
If you do not or cannot drink cow's milk (or goat and sheep) and rely solely on non-dairy milks, then this post is for you! It's high time for a nut milk makeover!! Not only to boost your health and keep your wallets a bit more full, but also to keep you out of the grocery store as often during these quarantine days. The only tools you need to make a creamy, rich, and smooth nut milk is a high speed blender and a fine mesh nylon nut milk bag. It's soooo simple to make and the quality and cost far outweighs what you can buy at the store. I know I might be preaching to the choir, but there is no shame in repeating it---because we all get lazy, me included. So here is some inspiration to cultivate a nut milk routine.
WHY YOU SHOULD PRIORITIZE HOMEMADE NUT MILK
Firstly, commercial nut and grain milks are expensive when really they shouldn't be. For example, Califia Almond Milk (which is one of my preferred commercial brands because it doesn't contain carrageenan and is fortified with calcium), costs ~$5 for 6 cups of nut milk. The ingredient list is as follows: water, almonds, natural flavors, calcium carbonate, sunflower lecithin, sea salt, locust bean gum, gellan gum, potassium citrate. For 45kcal per cup you get 450mg of calcium (via calcium carbonate fortification), and about 5 conventional almonds. That's it, for 80 cents per cup of non-organic nut milk. Wow.
Secondly, commercial nut and grain milks (and yogurts), are often lacking in calcium because the ingredients are naturally low in calcium. This is unfortunate because dairy free diets if not properly implemented with the guidance of a dietitian or knowledgeable health care provider, may contribute to calcium deficiencies. Some brands, like Califia, are fortified...which is great. However, they use calcium carbonate, a calcium supplement that has a low absorption rate. In addition, absorption is further compromised in situations where individuals have low stomach acid. As we age, we naturally produce less stomach acid, therefore the elderly struggle the most. However, even younger individuals live with inadequate stomach acid levels due to chronic stress, use of TUMS and PPIs, H. pylori infections, hypothyroid, etc. Furthermore, calcium carbonate can be constipating, and cause gas and bloating. So long story short, it's not ideal for many individuals, especially if you are dealing with digestive issues.
Thirdly, store bought nut milks contain a lot of stabilizers like locust bean gum, gellan gum, guar gum, xanthan gum, carrageenan, etc. Although these ingredients are deemed safe by the FDA, they may contribute to digestive symptoms such as bloating or discomfort in some individuals. I personally, try to limit gums and additives when possible.
IS THE COST AND TIME WORTH IT??
Heck yes! Why spend so much $$ on commercial non-dairy milks for such little quality?? If you are only getting 5-6 almonds per cup, with a good dose of poorly absorbed calcium carbonate, and a handful of fillers, why not make your own with a variety of nuts and seeds?!?
What is the cost? For organic, raw, sprouted, and fortified Mineral Rich Pumpkin Seed Milk, I spent close to $2.00 for a 48oz serving (including the fortification with supplements). This comes to about 35 cents per cup. Now, who can beat that price for the quality? If I wanted to increase the creaminess with a full cup of pumpkin seeds versus just a 1/2 cup, it would come to $3 for 48oz, or about 50 cents per cup. If you compare that to a commercial equivalent, Elmhurst Unsweetened Milked Almonds (which provides 19 almonds per cup and costs about $7), it would cost you about $1.75 per cup....and the nuts are not even organic, nor is there calcium added. So, you definitely come out on top if you make it at home. And if you think it takes too much time, think again. From start to finish it takes about 5 minutes to make homemade nut milk. Much less time than a quick grocery store run.
THE EVER CHANGING MINERAL RICH NUT MILK
So my version of nut milk, is not just any nut milk. Most recipes you see on the web are for almond milk, cashew milk, sunflower milk, etc. Yeah they are great, but why not mix it up a bit? Each nut and seed has unique nutritional benefits. Almonds are rich in vitamin E and magnesium, Brazil nuts are rich in selenium, pumpkin seeds are rich in magnesium and zinc, sesame seeds are rich in calcium, and on and on it goes. Why stick with just the same old almond, cashew, or even oat? Why not make a super rich and creamy nut/seed milk that is always changing??
In addition to choosing a variety of different nuts and seeds, I also make sure to add an easily absorbed powdered calcium supplement, either calcium citrate or whole bone meal powder. Calcium citrate is absorbed about 25% better than calcium carbonate and it does not require stomach acid for absorption. Sometimes, I also like to add sunflower lecithin powder for added creaminess and emulsification. Without the sunflower lecithin, homemade nut milks tend to separate. Plus there is an extra bonus because sunflower lecithin is an excellent source of choline! Unfortunately, 90% of Americans are not consuming adequate amounts of choline per day. Foods richest in choline include liver and egg yolks, as well as animal proteins. Some plants provide choline (Brussel sprouts, soy, and broccoli) but in much lesser amounts. Generally, women need at least 425mg per day and up to 550mg if they are breastfeeding. Therefore, sunflower lecithin can be a great tool for anyone limiting the previously mentioned foods.
HIGHLIGHT ON MY CURRENT FAVORITE NUT & SEED COMBO
These nuts are pretty amazing because just one nut meets over 100% of your daily selenium needs. What is selenium? It is a trace mineral that along with iodine, and zinc plays a very important role in healthy thyroid function and helps reduce oxidative stress within the body. A diet low in selenium can thus have far reaching effects on metabolism, energy, and ability to combat free radicals. However, as with everything too much can be harmful to our bodies as well. Since Brazil nuts are the most concentrated source of selenium, limiting yourself to 1-2 per day is all you need.
If you haven’t incorporated pumpkin seeds into your life, you should start now. These tasty seeds are super rich in minerals zinc and magnesium, both of which are very important for optimal health. Interestingly, many people tend to be deficient in magnesium, either due to poor intake of whole grains, nuts and seeds, or also because the soil is becoming more depleted of this mineral. Either way focusing on getting more magnesium into your diet can have far reaching positive effects. Magnesium can help reduce headaches, reduce cramping, increase overall energy, control blood sugar, and just generally help reduce inflammation. Plus, organic pumpkin seeds are very cheap. What more do you want?
So, get out your blenders, purchase a nylon nut milk bag (it makes all the difference, trust me), and get creative! Swap the pumpkin seeds for sunflower seeds for another low cost alternative, or use a variety of different raw nuts and seeds that you have available right now in your home. Either way, mixing it up, is the best. Out with the old, and in with the MINERAL RICH! No more slacking, it's time for a nut milk revolution!!
Fortified Mineral Rich Pumpkin Seed Nut Milk
Makes ~6 cups
1/2 - 1 cup raw organic pumpkin seeds (or whatever variety of raw nuts and seeds you wish to use)
1-2 organic Brazil nuts
2 tablespoons NOW Sunflower Lecithin Powder
3 teaspoons NOW Calcium Citrate Powder
1/4 teaspoon sea salt
Splash vanilla (optional)
1-2 tablespoons maple syrup/honey or 1-2 pitted medjool dates (optional)
Place the nuts and seeds into a bowl and cover with warm water. Allow the nuts and seeds to soak 4 hours or overnight. Strain and rinse the nuts and seeds and put them into the blender. Add 5 cups water and the remainder of the ingredients. Blend on high for 60 seconds or longer.
Line a bowl with the nut milk bag and pour the nut milk into the bag. Squeeze out the milk, leaving behind the nut pulp and fibers. Discard. Add an extra cup of water to your bowl to increase volume to 6 cups if desired. Transfer to a large jar or bottle and store in the refrigerator for up to a week.
Note: If you want to kick it up a notch you can also add 1 teaspoon of spirulina to the recipe. Read more about spirulina and its' benefits here, here, and here!
Nutrition Facts (per cup)- using 1/2 cup pumpkin seeds: 90kcal, 3.2g protein, 4.5g carbs, 7g fat with 23% of daily value of calcium, 16% of magnesium, 45% selenium, 5% of iron and zinc, and 17% of choline.
My Labor Story
It's been a year since Toren was born and I was reborn as a mother. I remember the days as if they were a vivid dream. Some moments remain crystal clear, while others seem like they belong to someone else. But I know, it was all me 100% of the time. Fortunately, I had a very easy pregnancy. During my first trimester I had some light spotting between weeks 6-8, and then afternoon fatigue around that same time. I also remember that my appetite was suppressed and I did not enjoy cooking. Luckily, around week 12, all that went away and my passion for cooking and eating returned. As the pregnancy progressed, everything else went smooth. I gained ~25lbs, which honestly looked like a lot more on my little frame. I am still amazed that I was able to walk let alone balance with all that weight in front of me. Although my pregnancy was easy, my labor and delivery were tough. In retrospect, I think I would do it all over again. Thirty-three hours of insanity for nine months of ease seems like a fair enough trade. In comparison to some moms I know, my labor story would be considered easy. But for me and many others, it would be considered a rough ride.
It all started after a wonderful blue bird day up at Mt. Baker. We decided to rent a cabin in Glacier and go snowshoeing for our last hurrah. It was a week before my due date and we knew it was "risky". Everyone thought we were crazy, but we didn't care. After a glorious day on the mountain concluding with a nice 20 minute hot tub soak, it began. I became Warrior Selva, excited, determined, and courageous. Little did I know that 24 hours later I would be scared for my life. Despite a supportive midwife, doula, and husband, I had to transfer to the hospital. Toren unfortunately was sunny side up and at an angle, causing me to involuntary bear down even though my body was not ready yet. After hours of involuntary pushing and in-between contraction shakes that caused my whole body to tremble rigorously, I was left feeling exhausted and defeated. I needed relief, I needed a break, and I needed to calm down. I believe my high stress and fear caused my body to start developing a syndrome called HELLP, a life threatening pregnancy complication, where the mortality rate has been reported to be as high as 30%. The hospital staff also informed me that there was a good chance that Toren may need to be born via C-Section. Luckily, upon arrival at the hospital, first the fentanyl and secondly the epidural, both saved my life. I was able to relax after four hours. I no longer had the shakes, I was able to "nap", and with the help of Pitocin, Toren was able to turn into the correct position. After seven hours of rotating from side to side with a peanut pillow between my legs, the nurse midwife told me I was ready to push. After an hour and a half, Toren entered our world without interventions. I was beyond relieved that it was over. We both survived and we were healthy. I also clearly remember hearing the nurse midwife comment on my placenta, "this is the largest, most robust placenta I have seen". And that made me proud :)
Thereafter, the hospital staff was mostly concerned with my recovery. Due to the HELLP syndrome my liver enzymes had shot up and my RBC and platelets dropped. They even wanted to give me blood. But luckily I recovered quickly and since I didn't have any symptoms (such as dizziness or changes in vision), they let us go home two days later. However, due to the many hours of involuntary pushing, I was very sore and swollen. My many nurses at the hospital often commented, "Oh, honey!" every time they examined me. I also had a vaginal wall tear that burned so bad every time I had to urinate. From there on out, recovery was a long road.
Although birth happens every day, a thousand times over, it is not a walk in the park. Many people unfortunately think women should be able to bounce back in no time. Three weeks leave should be enough time right? NO! Six weeks is not enough either! I often hear, "oh maternity leave must be so nice since you aren't working for three months. It must feel like vacation." Umm, no, it is definitely not vacation. Birth is very hard, becoming a mother is a huge transition, and some women may have additional complications with breastfeeding, a colicky baby, or postpartum depression. The Fourth Trimester should be a time where the community supports the new mom and baby. It should not be a period of time when the mother is given additional guilt.
With that said, I want to share some of my professional wisdoms to help support new moms in my community. To empower them with information that will hopefully ease the transition into motherhood. When I became a new mom I realized how little quality nutrition information was given from health care providers. At first I thought they didn't provide me with information because I was a dietitian. But as I asked around, none of my friends received any specific dietary recommendations besides "eat a healthy diet and take a multivitamin". First of all, what is a healthy diet postpartum? And what kind of multivitamin should be considered? Many people may think that a healthy diet means eating salads and smoothies every day for breakfast, lunch, and dinner. But unfortunately, this practice could leave the mom and baby nutrient deficient. Read on for my general recommendations during the Fourth Trimester to make sure you and your baby are getting the nutrients you need for health and recovery as well as breast milk quality.
The Fourth Trimester
Commonly called the Fourth Trimester, the postpartum period is a very critical time for both the new baby and new mom. Many people lose sight after delivery how important proper nutrition is after the baby is born because so much attention is placed on nutrition during pregnancy. But did you know that your nutrition needs actually increase after delivery? During the third trimester calorie needs are about an additional 450kcal per day while exclusive breastfeeding during the first six months requires on average 675kcal per day. Plus, that doesn't take into the account of the extra calories needed to recover from birth and the insane amounts of energy required during birth. This means that some moms require even MORE than that, especially in the immediate weeks following delivery! Thereafter, when baby starts to consume complimentary foods, energy cost of lactation is between 450-500kcal per day.
However, we cannot just focus solely on calorie needs but also the increased needs of certain nutrients that if not provided in adequate amounts via diet or supplementation can reduce the proper growth and development of baby. Furthermore, we cannot forget about mom! After delivery mom also requires special attention to certain foods for proper healing and recovery. And not to mention a lot of rest! Many traditional cultures encourage moms to stay home and heal for on average 40 days, with the first week considered a very fragile time with very limited movement and activity. Check out this book for inspiration. In today’s day and age we often don't give enough credit and attention to the needs of mom during the Fourth Trimester. The “Supermom” “Do it all” mentality is unrealistic and can also be detrimental to both mom and baby.
Highlighted Nutrients of Concern For Mom & Baby
Even if a mother is undernourished calories, protein, folate, and most trace minerals are sufficient in the breast milk to ensure survival of the infant by relying on the mother’s stores. However, for other nutrients such as B vitamins (besides folate), fat soluble vitamins A, D, E, and K, choline, fatty acids (such as DHA), and certain trace minerals iodine and selenium, the mother’s diet does affect the amounts found in the breast milk. Compared with pregnancy, lactation requires not only more calories but also more nutrients. Furthermore, radical dietary changes will drastically impact the quality of breast milk. Low calorie diets less than 1800kcal per day and drastic dietary changes, such as very low carbohydrate or low fat diets, can impact breastmilk production. Therefore, it is not recommended to restrict carbohydrates, fats, or proteins while breastfeeding without possibly reducing breastmilk production and quality.
It is essential to honor your hunger cues during the postpartum period. If you have been following a low to moderate carbohydrate diet (~90-150g per day) throughout pregnancy to manage gestational diabetes or weight gain, it is fine to continue this during lactation. However, if you start to restrict carbohydrates drastically after delivery in hopes to lose weight then this may negatively impact breastmilk production as well as adrenal and thyroid function. Carbohydrate needs depend on a variety of factors. In my practice I have found a range of 30-40% of calories (or about 170-230g of complex carbs based on a 2300kcal diet) to work for most lactating women. However, it is best to work with your dietitian to find a carbohydrate range that will best support you through the postpartum period. Furthermore, pairing these complex carbohydrates with quality fats and proteins helps stabilize blood sugars, providing more stable energy, and reducing added stress on the adrenal glands. Aiming for around 100g of protein per day, divided between meals and snacks, is a good baseline for most nursing moms. Furthermore, protein rich foods are often excellent sources of the highlighted nutrients below. Quality fats provide the remaining energy, omega-3 fatty acids, and are essential for the absorption of fat soluble vitamins.
Women who consume vegan or vegetarian diets are at a high risk of developing vitamin B12 deficient milk. Inadequate vitamin B12 content in the mother’s diet or lack of supplementation can cause the infants brain to shrink and present itself as irritability, failure to thrive, and anorexia with severe growth stunting. Tip: Add in B12 rich foods daily via clams, liver, eggs, seafood, and animal meats. If vegan, supplementing with 1000mcg of cyanocobalamin bi-weekly (or this product once weekly) can help maintain adequate vitamin B12 stores. Recommendations change if you have been diagnosed with a deficiency.
Choline needs increase dramatically during lactation and is essential for proper brain development along with folate. Adequate choline intake increases memory capacity and prevents age-related memory and attention deficit. The estimated daily need is 550mg per day for breastfeeding moms. Foods rich in choline include eggs (150mg per egg), oysters (110mg per 3oz), and organ meats (liver – 360mg/3oz and kidney 440mg/3oz). Many traditional cultures encourage plenty of choline rich foods in the postpartum period with some eating 8-10 eggs per day! Unfortunately, many young women are not getting enough choline through diet alone. Plus, many multivitamins contain only very little choline or none at all. Once again vegans or vegetarians are most at risk for inadequate choline intake. Tip: Recommend eating choline rich foods daily and ensure additional choline content in multivitamin. Additional supplementation for mother’s eating a vegan or vegetarian diet may be warranted.
Worldwide many people are at risk for iodine deficiency due to low intake of seafood and seaweed, iodine deficient soil, increased exposure to chlorine, and limited use of iodized salt. Iodine plays an essential role in thyroid health and metabolism. In infants the iodine pool turns over rapidly and therefore requires a consistent, steady source of iodine via the maternal diet to make sure baby gets enough. Tip: Add dulse flakes when cooking savory meals, add a kelp frond to soups, and enjoy quality seafood, eggs, and dairy often. Also, check your multivitamin to see if there is added iodine.
Fat Soluble Vitamins A & D
Both vitamin A and vitamin D are crucial for infant growth, immune system development, and prevention of infection. Vitamin A needs increase significantly during lactation. However, just eating carrots or sweet potatoes will not provide enough of the active pre-formed vitamin A (retinol) that is required. You will also want to be careful with supplements that provide only beta-carotene for vitamin A supplementation. Research found that women who supplemented with only beta-carotene (without the pre-formed vitamin A) had vitamin A deficient breast milk 40% of the time vs. 4% in women whose multivitamin contain both beta-carotene and retinol. Furthermore, you need fat in your diet in order to absorb fat soluble vitamins. If fat is restricted due to weight loss goals, the content of fat soluble vitamins (such as vitamin A, E, K, and D) in breastmilk will be lower. Tip: Animal fats and organ meats are a great source of pre-formed vitamin A, including egg yolks and grass-fed butter, as well as liver.
Breast milk has long been noted to be vitamin D deficient and exclusively breast fed infants are encouraged to supplement with additional 400IU of vitamin D/day. Exposure to sunlight via mother’s skin during the months of March through September can provide a good source of vitamin D. Additional vitamin D3 supplementation of 1000-2000 IU/day is also recommended to maintain blood serum levels of 40-60ng/mL. Alternatively, recent research has found that mothers can increase their supplementation dose to 6400IU per day to ensure adequate vitamin D3 in breastmilk for the infant. Therefore, eliminating the need for additional baby vitamin D3 drops. Tip: recommend all breast feeding mothers check their vitamin D3 status and adjust supplementation per health care provider recommendations.
DHA & Fatty Acids
The maternal diet directly effects the fatty acid content of breast milk. Omega-3 fatty acids have been found to be especially important for infant brain development. Infants whose mother’s had high DHA levels have improved neural and visual development. Dietary choices definitely make a difference. Women who eat on average of 4.5oz of seafood/day have DHA concentrations of about 2.8% whereas vegan mothers only have a DHA concentration of about 0.05%. Furthermore, DHA levels are only adequate in breastmilk when mothers diet contains omega-3 rich foods or supplements consistently. Tip: Consume low mercury seafood like salmon and sardines, grass-fed beef and eggs, and continue to take a quality DHA fish or algae oil supplement while breast feeding. Flaxseed oil supplementation does not increase DHA in breast milk.
Highlighted Nutrients of Concern For Healing & Recovery
Mom's go through the wringer. Whether it was a long labor, vaginal tearing, or a c-section, healing needs are high postpartum. Tissues that have been stretched, torn, or cut require additional protein for regeneration and repair. The amino acids proline and glycine are especially important because your body uses these to make collagen for the regeneration of connective tissue and skin. Foods rich in collagen like bone broth, slow cooked meats, chicken skin, fish skin, or pork rinds will provide these amino acids. Check out my recipe for a collagen rich bone broth here. Tip: Aim for 12-15g of collagen protein per day. You can also use collagen peptide powder supplements for ease.
Furthermore, iron rich foods like organ meats, grass-fed beef, and oysters can be especially helpful to replace iron lost during birth and the days following. My Blood Building Liver Pate is a family hit and an excellent way to provide nutrients for RBC production, including iron, folate, B12. Plus, did you know that vitamin A plays an essential role in iron metabolism? Research has found that vitamin A supplementation along with iron supplementation improves anemia better than iron supplementation alone. Liver, once again, is an excellent source of vitamin A.
Finally, plenty of fluids are essential for mama and baby during the postpartum period. During the first two weeks when hormones levels are fluctuating and leaving you soaked upon waking, fluid and electrolyte needs are very high. Therefore, it is recommended to aim 3-4L per day, including savory broths, warm beverages, and coconut water to help replace electrolytes. Thereafter, aiming for 3L per day while breastfeeding is adequate.
If you have made it this far, I applaud you! As you can see warming and hearty meals rich in animal proteins, offal, and quality fats, is an essential part of a quality postpartum diet. Don't get me wrong, vegetables and fruits are important too, but they should not be the only focus. Raw vegetables can be difficult to digest, and during the early period of recovery, cooked vegetables are easier on the digestive tract allowing for enhanced absorption of nutrients. Gentle starches such as cooked tubers, squash, and well-cooked grains can help provide sustained energy when paired with quality proteins and fats. Raw fruit when paired with a fat or protein can be an excellent snack. For example, diced strawberries topped with organic whipped cream, a diced kiwi served with organic whole milk yogurt, or a pitted medjool date stuffed with almond butter. Getting enough calories is important as well. If you are hungry, please eat! Even if it is in the middle of the night between feeds. Avoid skipping meals or going too long between meals. Simply honor your hunger. Finally, it can be helpful to work with a skilled dietitian to help guide you through the postpartum period. Additional labs and supplements can be helpful in varying cases, especially if energy/vitality is low, anxiety/depression persists, or nutrient deficiencies are noted by your health care provider.
If you would like more in depth nutrition information to support the postpartum period and breast milk quality, then please join me at the Bellingham Center for Healthy Motherhood on select dates. For more information regarding this class click here.
2) Women's Health Nutrition Academy. Postpartum Recovery & Nutrient Repletion presented by Lily Nichols.
5) Women's Health Nutrition Academy. Nutrition for Breastfeeding presented by Lily Nichols.
Like to read? Then get your evidence based nutrition information here! All posts written by Selva Wohlgemuth, MS, RDN Functional Nutritionist & Clinical Dietitian